Will consultant led care dash my dreams of a home birth?

[Sundaylunchhappy]

Just that really.

To my complete surprise I was told at my booking appointment that I would be under clc due to recently being discharged from a consultant gynaecologist.

However the whole reason for being referred to them in the first place was due to pain during pelvic exams and intercourse... which quite obviously I've overcome. The diagnosis I was given was vaginismus, a learnt disorder that causes spasm. Now a huge part of that was allowing time to mentally feel completely relaxed and safe, which is why if it's not considered too risky, I'd dearly hope to have my baby at home.

From what I've read on dr Google, consultant led care appears to put the lid on home birthing from the get go, any ideas on how I can question their decision without bothering to check the full history?

It's probably just the case that the rules say 'recent gynaecological problem = CLC' and the person who made the decision doesn't have the seniority to change it. Once you have seen the consultant for the first time, you may well find yourself put back to 'normal' antenatal care, given that your problem has been dealt with and doesn't seem to have any implications for pregnancy/birth.

I'm thinking that as a midwife gathering all recent medical history, it might just be a precautionary step. I really hope that once I've seen the consultant, I can be refered back to 'normal' midwife led care.

I'm not sure whether I was consultant led care, or midwife - but I was technically under the consultant as I was 'ancient' (over 40). My general check appointments were with midwife. I wanted a home birth and had to go see the consultant to discuss. I went, had a brief chat, he looked at my notes etc and said no problem - I had no health issues at all apart from being old! I had a home birth and was everything I had hoped - quick, chilled, intimate (after 2 hospital births previously experience of which I hated - long, painful).

Vaginismus is not a contraindication for a homebirth. In fact it would probably be within your interests to go down that route for continuity of care. If that's the only reason I'm sure you will be discharged to MW led care

Mummyme87 that's exactly what I thought! The whole principle behind overcoming the condition is to build up confidence and I'm terrified of feeling like the whole situation will be taken out of my control. I'm not naive, I know under certain circumstances I will need intervention and to be hospital, but that's not what I want to plan for.

You might find that once you've met your consultant they'll refer you back to midwife led care. DS was born at 36 weeks, and when I was pregnant with DD I was initially under clc due to a previous premature birth. I met the consultant at my 12 week scan appointment and after going over my notes she was happy that it was unexplained, I was healthy, and I was put over to midwife led care.

Have you had other children if so what was your first birth experience like I think if your first went smoothly you'd be able to go for a home birth i was told after delivering my second that I could've had a home birth while under consultant led care for kidney stones and previous premature birth.
Your consultant may also just have a look and send you back to midwife led care.
Hope everything works out the way you want it to :)

Just remember that it's your body and your baby. MW and consultants may offer advice but ultimately any and all decisions about your birth is up to you.

Only you chose where you birth - you don't need any permission. You may of course want information and discussion but you have not lost any of your bodily autonomy. If you are happy with your informed choice to be at home then you chose to be there. MWs will attend but it could be noted it's against recommendation - if the community team didn't have capacity then you call 999

I was consultant led from 21 weeks until 36 weeks,regular appointments, shortening of my cervix, high risk and on progesterone pessaries. When I got to 36 weeks I was signed back to midwife led care and then considered low risk. I didn't opt for a home birth as didn't want to, but was offered it and had my DD on the midwife led unit. Clc doesn't always mean that labour ward is the only option :)

You can decline consultant led care if you want to. I did. I was offered a referral with my second pregnancy because I had a crash section with my first. Having discussed it with my midwife at my first appointment, researched as much as I could, and having satisfied myself that there was no evidence that the issues were likely to recur, I opted for midwife-led care and had a completely straightforward and lovely home birth for my second baby (and subsequently my third also).

The medical professionals are there to give you information and advice, but you can make your own decision at the end of the day. Best of luck with your pregnancy and birth.

Thank you for the further replies and sharing of experiences.

Just having a look at my notes this morning and noticed a tick in the box on the front that says choice of place of birth: xyz hospital. I did not at any point get asked about that!

My first consultant appointment is just under two weeks away and I think he works alongside the consultant I was under previously so will hopefully also know lots about the condition I had.

This is first baby, so I know the odds are a bit against me for support regarding home birth, I'm not going to go against strong medical advice, I just don't want my hopes and wishes to be written off so early without understanding why.

Blimey, that turned into a rant! Thank you again for your posts, definitely feeling a little calmer about the conversations that'll be had.

I have a history of chronic vulval pain (vulvodynia in my case) and had seen a gynaecologist. When I told the midwife about it, I asked to see the consultant for a discussion about my condition and how it might affect my birth and birth choices. She referred me for the appointment but still put me down for midwife-led care because she said I could still have the appointment without having to be consultant-led. So as PPs have said, the consultant will hopefully refer you back to the midwife-led pathway. And please do point out at your consultant appointment but also your next midwife appointment that your preference is for a home birth, not a hospital birth, and it has been recorded wrongly in your notes.

By the way, I strongly recommend pregnancy yoga and hypnobirthing to help you feel relaxed and positive about the birth. They really helped me. In the end I didn't have the birth I wanted (I wanted to be in the midwife-led unit but was transferred to the delivery unit for monitoring) but the yoga and hypnobirthing were still worth it, definitely.

I'm 36 weeks and was initially under CLC for one thing or another however they have discharged me after a few extra appointments and scans and all being well. No reason why they won't do the same for you!

They have no power to force you to do what you want. If you want a home birth, you can have one. They are legally responsible to make sure you have adequate care during your labour and delivery and if you want to have a home birth they will send someone out to you. There isn't any such thing as 'not allowed'.

I had a c-section with my first baby and planned a home birth. They weren't happy about it. I had to have a senior midwife come out and explain I was going against their advice, the dangers involved.

When you next see your midwife tell them you want a homebirth. They will try and sway you, but they have to put things in place for you if that's what you want.

It's your body!

Sorry that should say I planned a home birth with my second baby. My first baby was a c-section.

I had a similar experience ( but Clc for different reasons) and was really upset at booking about not being able to go to the midwife led unit as I'd imagined.

However, it turned out to be a positive thing. I had complications during pregnancy that I hadn't foreseen and the extra scans I got really helped to put my mind at rest.

If you are dead set on it and really think it will make a difference to you then talk it out with your consultant and midwife. How far are you from hospital if you need to be transferred for EMCS or monoitoring?

I only ask because it is a consideration in your planning. I had planned to hyponobirth (still good relaxation in those frustrating final weeks) and only have had and air. As it turned out I have fast labours and no latent phase so had contractions two minutes apart within 45mins of kick off and was 6cms by the time I got to hospital. DD became distressed and I ended up with an EMCS.

But it was fine. I had no idea that I had fast labours or that I wouldn't have time to hypnobirth or that I would need an EMCS. All I would say is factor the unknown into your planning. I hated the idea of being clc but it turned out best for me.

It sounds like an automatic tick box thing - your midwife will not want to take the responsibility of a possible complication after saying you were "low risk". However, the advice above is absolutely right - I can't see any reason why vaginismus should preclude a planned home birth, in fact more reason to have one. I'm sure your consultant will be happy to sign off on this, and if they aren't, get another opinion!

I would like to comment on something re. other advice above though, for other people reading too: It's true you can decline whatever care options are recommended. But this idea that "they have to make sure you have adequate care" - adequate how...? In the situation above, one complication of VBAC is uterine rupture. Midwives and doctors can "support" your choice in that they can put as much in place as possible to plan around your decision, but there's nothing they can do to stop a baby being born at home from being harmed by a uterine rupture, I don't care how fast that ambulance is! So, is that "adequate"? They can do their best given the limitations, but they cannot stop risky choices from being risky.

I had a home VBAC. My local hospital 'require' continuous foetal monitoring - i.e. it was presented to me as 'you have to have this' I knew that I could not cope with being confined to the bed (I need to pace and be mobile in labour) and my local hosp doesnt offer a mobile monitoring device. According to my midwife, there is no evidence that cfm produces better outcomes or is safer than intermittent monitoring. I had intermittent monitoring at home and was satisfied that this reduced my risks of an undetected uterine rupture to an acceptable level. I felt confident that I would be transferred (local maternity hospital less than 10 mins drive away) very promptly if anything were to cause worry, and I understand that foetal heartrate changes are one of the very early signs of a rupture. I also understand that the increase in the risk of uterine rupture as a result of a previous section is quite small.
Some people are very risk-averse and want to be in hospital with all the doctors, equipment and everything right there. But being in hospital carries its own risks. It is up to the individual to ask questions, research and work out what decisions they are happy with. In my case, I was freely offered a home VBAC and it was never suggested to me that it was a dangerous choice. No birth is entirely risk-free.

I would like to comment on something re. other advice above though, for other people reading too: It's true you can decline whatever care options are recommended. But this idea that "they have to make sure you have adequate care" - adequate how...? In the situation above, one complication of VBAC is uterine rupture. Midwives and doctors can "support" your choice in that they can put as much in place as possible to plan around your decision, but there's nothing they can do to stop a baby being born at home from being harmed by a uterine rupture, I don't care how fast that ambulance is! So, is that "adequate"? They can do their best given the limitations, but they cannot stop risky choices from being risky.

Adequate care just meant they have to send someone to attend the home birth.

I was CLC (for something different). They signed me off at 34 weeks, then the midwife suggested a home birth, personally can't think of anything worse! But if you can get the CLC signed off, or their OK, then you can have one.

I was under CLC. High risk pregnancies. Home births. All of them, including the first.

Nothing high risk about the births, just the need to keep them in there long enough.

I had a home birth with my first and planning another with my 2nd now. There's no reason they can't and won't support you for a home birth with your first (in fact, they have to, they have the duty of care to, even if you were to be genuinely classed as high risk).

But I would do as you're doing, go see the consultant, explain your decision to birth at home and say that's where you think you'll be able to be most comfortable and relaxed, and say you don't wish to have any more consultant appts. You can decline consultant led care and it really doesn't seem like you need it. It sounds like the are being overly cautious and a bit silly to be honest, so I suspect you'll be discharged then.

I was seeing a gyno just before I got pregnant as I had some pelvic floor dysfunction and urinary incontinence related to my first birth (which was 4 years ago but it just flared up recently). I also had a miscarriage the month before I got pregnant with this baby and needed to have a d&c (so major gyn surgery). None of that raised any red flags and I've been midwife led care and with the home birth team from my initial referral. So it really shouldn't be an issue, but good just to have a conversation about it and tell them you don't need them.